Validating Endoscopic Retrograde Cholangiopancreatography in Jamaica: A Retrospective Audit

During the first 36 months after its introduction to Jamaica, ERCP was performed with relatively high overall morbidity and poor therapeutic success. We sought to evaluate outcomes after eight years of experience with ERCP at a tertiary level hospital in Jamaica. All consecutive patients who had ERCP performed between March 1999 and March 2007 were identified from an operative log. Their hospital records were retrospectively analyzed. There were 369 procedures performed over the study period, but the final analysis was performed on 301 patients who met the inclusion criteria. There were 79 males and 222 females, with a mean age of 45.0 years (SD +/-18.6; range 14-94). There has been a reduction in the incidence of post-ERCP pancreatitis (5.3% vs. 10%) and overall morbidity (24/301; 7.97% vs. 12.5%). The commoner complications included pancreatitis (16/301; 5.32%), ascending cholangitis (8/301; 2.66%), perforation (0) and hemorrhage (0). There were 4/301 (1.33%) deaths directly resulting from an ERCP complication (ascending cholangitis in 3; multiple organ failure from severe pancreatitis in 1). There has also been improvement in the success of stone clearance from the common bile ducts (55/72; 76.39%) and biliary stenting (32/36; 88.89%). Currently, local endoscopists are performing ERCP with acceptable morbidity and mortality compared to international standards.